Provider Demographics
NPI:1962533679
Name:OBI N NWASOKWA, MD, PHD, PC
Entity type:Organization
Organization Name:OBI N NWASOKWA, MD, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:OBI
Authorized Official - Middle Name:N
Authorized Official - Last Name:NWASOKWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-479-7808
Mailing Address - Street 1:12 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1142
Mailing Address - Country:US
Mailing Address - Phone:718-479-7808
Mailing Address - Fax:718-479-7491
Practice Address - Street 1:19719 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2126
Practice Address - Country:US
Practice Address - Phone:718-479-7808
Practice Address - Fax:718-479-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169721207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01045743Medicaid
NY94D022Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY61136Medicare ID - Type UnspecifiedGHI MEDICARE
NY01045743Medicaid